Spring Cleanse Boot Campa Health History & Registration Form

Contact Information

Bootcamp Type & Location *

When would you like to start bootcamp? *

Please use MM-DD-YYYY format for entering the date in this field

First Name *

Last Name *

Email *

Birthday (MM-DD-YYYY)*

Company Name

Job Title

Street Address1 *

Street Address2

City *

Province *

Postal Code *

Primary Phone Type *

Primary Phone Number *

Primary Phone Extension

Alternate Phone Type

Alternate Phone Number

Alternate Phone Extension

Weight (lb) *

Height (in) *

Gender *

	Male
	Female

Primary Goal *

How did you hear about our Spring Cleanse Bootcamp

I was referred by...
Person's First Name

Person's Last Name

Health History & Medical Information

Health History

please enter any specific medical details, injuries, or information that the Spring Cleanse Bootcamp team should know prior to you starting this program

Please check all that apply

For any checked boxes, please provide a detailed explanation in the text area below as this will help us provide you with a safer and more effective camp experience!

Heart Condition or Chest Pain
Do you Smoke?
High Blood Pressure
Low Blood Pressure
Asthma
Arthritis
Hernia
Back Problems
Pregnant or Breastfeeding
Joint Problems
Medications (Type, Dosage)
Recent Surgeries
Physical Exam in last 12 months

Additional Info

Please let Us Know of Programs You are Interested In Learning More About From TaMeri, Inc.

Basic Life Support (American Heart Association)
Freedom From Smoking (American Lung Association)
Hypnosis
Anger Management
Stress Management
Meditation
Yoga
Would Like to Receive Monthly E-Newsletter

Acceptance of Waiver and Policies

Waiver & Release of Liability

The services provided by TaMeri Inc./Maat Hypnosis are based upon scientific principles and knowledge that are constantly being changed and updated. Therefore, changes in training practices and educational teachings will vary over time as new scientific information becomes available. As a customer, I, <PARTICIPANT NAME> (herein after referred to as I, or the undersigned), have made certain representations as to my physical condition, workout regimen, and diet, which cannot be confirmed or denied by TaMeri Inc./Maat Hypnosis. Therefore, I am solely responsible for providing detailed, truthful, and accurate information to TaMeri Inc./Maat Hypnosis. During training, consultations, or educational sessions, TaMeri Inc./Maat Hypnosis may provide links or references to information provided by third parties for which it makes no representations or warranties thereto.

I, expressly and affirmatively state that I wish to participate in Bootcamp programs, health & fitness training and/or education services offered by TaMeri Inc./Maat Hypnosis. Under no circumstances, and under no legal theory, willTaMeri Inc./Maat Hypnosisbe liable to myself for any damages, including lost profits, lost time, or other indirect, special, incidental or consequential damages arising out of from my participation in any activities recommended, supervised, or instructed by TaMeri Inc./Maat Hypnosis or any of its authorized agents or from my use of equipment or machinery involved in the recommended or supervised activities. The limitation from liability shall apply to death and personal injury to the maximum extent permitted by law. My sole and exclusive remedy for any breach of warranty or purpose is that the company will, at its option, review and revise my information or provide credit for additional services.

I have been informed, understand, and am aware that physical fitness training including, but not limited to strength, flexibility, and cardiovascular exercise, including the use of equipment, are potentially hazardous activities and can involve the risk of serious injury. I am voluntarily participating in these activities, using the equipment and machinery, with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury resulting from my participation in these activities.

I understand that during a Bootcamp program or fitness training session, my trainer may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted. If I feel at all uncomfortable or experience any type of discomfort with the usage of touch, I will immediately request that my trainer discontinue using Touch Training.

I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment or machinery except as herein stated.

Consent to Waiver *

Yes

Spring Cleanse Boot Camp Policies & Procedures

Sessions must be paid in advance, unless special arrangements are made (e.g credit card on file). Payments may be made by cash, personal cheque (should be made payable to TaMeri, Inc), credit card (Visa/MC/AMEX), or debit. If a cheque is returned NSF, a $25 fee administrative fee will be levied, you will be responsible for any additional bank charges incurred and cash will be required for all future payments. Sessions payments are non-refundable.

If you are unable to attend camp due to circumstances out of your control, we can offer you a refund if you notify us prior to your session start date. However a $100.00 cancellation fee will be charged. If we are notified of the cancellation after your session begins, we can only give you a pro-rated credit towards another boot camp. This credit is nontransferable. There is no cash refund. There is no refund for merely changing your mind! We are here to get you results and these results cannot be achieved if you fail to attend the camp! These policies are not negotiable.

You are expected to arrive on time to camp to ensure a proper warm-up (reduces the risk of injury), avoid inconveniencing and disrupting the instructor and other campers, and so you get the maximum benefit from the program.

Be prepared to get wet, dirty, sweaty, and dress accordingly.  Most importantly, HAVE FUN!

Thank You!

By clicking the button below, I acknowledge that I have truthfully completed both the agreement and release of reliability and the policies and procedures sections. I have read and understood these statements, and had any questions regarding the above stated information answered to my satisfaction.

Consent to Policies *

Yes

Please Note You will Receive a Confirmation Letter and Payment Information
as soon as we are able to process your request.